CHEMICAL EXAM prt.1.2

Question 1

pH

•Kidneys secrete hydrogen in the form of (3) and reabsorb____

Answer 1

ammonium ions
hydrogen phosphate
weak organic acids

bicarbonate

Question 2

NORMAL pH VALUES

• Random urine pH:________

• First morning urine pH (healthy individual):______

Answer 2

4.5 to 8.0

5.0 to 6.0

Question 3

pH of______ or higher: NOT NORMAL!

• This suggests contamination, bacterial overgrowth, or improper sample storage.

• pH values above 8.0 or below 4.5 are physiologically impossible and indicate potential _____

Answer 3

9.0

adulteration or contamination.

Question 4

Normal values for pH

Answer 4

NO NORMAL VALUES: Must be considered in conjunction with other patient information

Question 5

FACTORS AFFECTING URINE pH

Diet and Medications

• High-protein diets →_____

• Vegetarian diets (except cranberry juice) →______

• Cranberry juice →______(prevents bacterial growth)

Answer 5

Acidic urine

Alkaline urine

Acidic urine

Question 6

Clinical Uses of pH Management
1. Diagnosis of systemic acid-base disorders

• Acidic urine →________

• Alkaline urine →________

Answer 6

Metabolic or respiratory acidosis (unless caused by renal disease)

Metabolic or respiratory alkalosis (unless caused by renal disease)

Question 7

Clinical Uses of pH Management

2. Management of urinary conditions

• Kidney stone prevention:
• ______stones form in___(pH) urine.
• Maintaining____(pH) urine discourages stone formation.

Answer 7

Calcium oxalate

acidic

alkaline

Question 8

CLINICAL SIGNIFICANCE

2. Management of urinary conditions

Urinary tract infections (UTIs):

•_____(pH) urine inhibits the growth of urea-splitting bacteria (e.g., Proteus, Klebsiella, Pseudomonas).

• Maintenance of_____(pH) urine helps treat UTIs.

Answer 8

Acidic

Question 9

pH

Physiologically impossible! Suggests urine adulteration (e.g., acidification with chemicals).

Answer 9

<4.5

Question 10

pH

Physiologically impossible! Suggests:

1. Iatrogenic alkaline contamination (e.g., from medical interventions).
2. Improperly stored urine specimen (bacteria decompose urea into ammonia, increasing pH).
3. Contamination with an alkaline chemical.

Answer 10

> 8.0

Question 11

> 8.0

Physiologically impossible! Suggests:

Answer 11

1. Iatrogenic alkaline contamination.
2. Improperly stored urine specimen
3. Contamination with an alkaline chemical.

Question 12

pH

NOTE:
1. Maintaining urine at an alkaline pH discourages formation of the____
2. Maintenance of an acidic urine can be of value_____

Answer 12

calculi

(UTI) treatment

Question 13

@Most indicative of renal disease

Answer 13

PROTEIN

Question 14

Normal urine contains very little _____

Answer 14

PROTEIN

Question 15

Major serum protein found in urine:

Answer 15

ALBUMIN

Others:
microglobulins
uromodulin (Tamm-Horsfall protein)

proteins from prostatic, seminal, and vaginal secretions

Question 16

Normal urine protein consists of:

•________ that are small enough to be filtered by the glomerulus but are mostly reabsorbed in the proximal tubule.

• Proteins secreted by the____

Answer 16

Low molecular weight (LMW) serum proteins

genitourinary tract (non-renal sources)

Question 17

does not always signify renal disease (more tests required to determine if the it present is pathologic or physiologic)

Answer 17

proteinuria

Question 18

*Causes of proteinuria can be grouped into three major categories:

Answer 18

Pre-renal
Renal
Post-renal

Question 19

PRE-RENAL PROTEINURIA

•Caused by increased levels of LMW plasma proteins that exceed the normal reabsorptive capacity of the tubules

Answer 19

Hemoglobin
Myoglobin
Acute phase reactants

Question 20

Caused by conditions affecting the plasma prior to reaching the kidney

•NOT INDICATIVE OF ACTUAL RENAL DISEASE

Answer 20

PRE-RENAL PROTEINURIA

Question 21

Now:

cases of multiple myeloma are easily detected by chemical methods and diagnosed by____ (classic ‘_____ spike’ in the gamma globulin region) and immunoelectrophoresis

Answer 21

serum electrophoresis

M spike

Question 22

• Monoclonal immunoglobulin light chains excreted by patients with multiple myeloma

Answer 22

BENCE-JONES PROTEIN

Question 23

Historical screening test for BENCE-JONES PROTEIN

If protein coagulates (becomes turbid) at ________ and dissolves (clears) at_______ (other proteins remain coagulated

Answer 23

40°C and 60°C

100°C

Question 24

occurs when the kidneys themselves are damaged, leading to the loss of proteins in the urine

Answer 24

Renal proteinuria

Question 25

May be the result of either glomerular or tubular damage

Answer 25

Renal proteinuria

Question 26

RENAL PROTEINURIA "May be the result of either glomerular or tubular damage (4)

Answer 26

• Glomerular proteinuria • Microalbuminuria • Orthostatic (postural) proteinuria •Tubular proteinuria

Question 27

presence of abnormal substances in the glomerular membrane may damage the glomerular membrane

Answer 27

GLOMERULAR PROTEINURIA

Question 28

CAUSES OF GLOMERULAR PROTEINURIA (3)

Answer 28

Amyloid material in amyloidosis (buildup can cause organ failure) Toxic substances Immune complexes (main cause)

Question 29

increased pressure from the blood entering the glomerulus May be reversible or transient (strenuous exercise and dehydration, hypertension, pregnancy)

Answer 29

GLOMERULAR PROTEINURIA

Question 30

urinary albumin excretion of 30-300 mg/day, or 20-200 g/min Amount of urinary albumin greater than the normal value, but also lower than what is detected by a conventional dipstick

Answer 30

MICROALBUMINURIA

Question 31

MICROALBUMINURIA urinary albumin excretion of______ or ______ Amount of urinary albumin greater than the normal value, but also lower than what is detected by a conventional dipstick

Answer 31

30-300 mg/day 20-200 g/min

Question 32

Common in patients with early-stage diabetic nephropathy leading to reduced glomerular filtration

Answer 32

MICROALBUMINURIA

Question 33

• early-stage diabetic nephropathy • Poor glucose control inhibits N-deacetylase needed to form the heparan sulfate •Decreased proximal tubular albumin reabsorption

Answer 33

MICROALBUMINURIA

Question 34

MICROALBUMINURIA/ MICRAL TESTING ***Micral-Test Reagent Strips*** Contain_______

Answer 34

gold-labeled antihuman albumin antibody-enzyme conjugate

Question 35

Micral-Test Reagent Strip Principle of the Micral-Test Contain _____-labeled antihuman albumin antibody-enzyme conjugate Strips are dipped in urine for ____ seconds and compared with the color chart after____ _____in the urine binds to the antibody. The bound and unbound conjugates move up the strip by wicking action. Unbound conjugates are removed in a captive zone by combining with albumin embedded in the strip. The urine albumin-bound conjugates continue up the strip and reach an area containing enzyme substrate. The conjugated enzyme reacts with the substrate, producing colors ranging from white to red. The amount of color produced represents the amount of albumin present in the urine.

Answer 35

gold 5 seconds; 1 minute Albumin

Question 36

Occurs following ***long periods spent in a vertical position*** and ***disappears when a horizontal position is assumed***

Answer 36

ORTHOSTATIC PROTEINURIA

Question 37

ORTHOSTATIC PROTEINURIA Due to increased pressure on the ______

Answer 37

Renal vein

Question 38

ORTHOSTATIC PROTEINURIA Collect urine after ______and another specimen after______ Orthostatic proteinuria: if specimen 1 is______ for protein and specimen 2 is_____ for protein

Answer 38

waking up; after remaining in a vertical position for several hours negative; positive

Question 39

•Failure to reabsorb filtered albumin

Answer 39

TUBULAR PROTEINURIA

Question 40

TUBULAR PROTEINURIA Causes:

Answer 40

exposure to toxic substances and heavy metals severe viral infections Fanconi syndrome

Question 41

A defect of proximal tubule leading to malabsorption of various electrolytes and substances that are usually absorbed by the proximal tubule

Answer 41

Fanconi syndrome

Question 42

***Bacterial and fungal infections and inflammations*** produce exudates containing ***protein***

Answer 42

POST-RENAL PROTEINURIA

Question 43

Presence of blood from injury or menstrual contamination

Answer 43

POST-RENAL PROTIENURIA

Question 44

Prostatic fluid and large amounts of spermatozoa

Answer 44

POST-RENAL PROTEINURIA

Question 45

A cold precipitation test that reacts equally with all forms of protein

Answer 45

SULFOSALICYLIC ACID TEST

Question 46

SULFOSALICYLIC ACID TEST Add_____ ml of _____ SSA reagent to_____

Answer 46

3 ml of 3% SSA 3 ml centrifuged urine

Question 47

PROCEDURE FOR SSA TEST 1. Centrifuge the_____ to remove any cellular debris or contaminants. 2. Take_____ of the supernatant (clear urine portion). 3. Add_____. 4. Observe for turbidity (cloudiness) and grade the reaction.

Answer 47

urine sample 3 mL 3 mL of a 3% Sulfosalicylic Acid (SSA) reagent